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(Stroke. 2009;40:2251.)
© 2009 American Heart Association, Inc.

Topical Reviews

Management of Blood Pressure for Acute and Recurrent Stroke

From Neurological Intensive Care (V.A.) and the Center for Stroke Research (P.B.G.), Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Ill.

Correspondence to Venkatesh Aiyagari, MBBS, DM, Co-Director, Neurological Intensive Care, Department of Neurology and Rehabilitation, University of Illinois at Chicago, 912 S Wood Street, Room 855N, Chicago, IL 60612. E-mail aiyagari@uic.edu

Marc Fisher MD Kennedy Lees MD Section Editors:

Key Words: acute stroke • blood pressure • hypertension • intracerebral hemorrhage • recurrent stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Hypertension is the most important modifiable risk factor for stroke.^1,2 It is estimated that 25% or more of strokes may be attributable to hypertension. Because many patients with stroke have mild hypertension or prehypertension, we have shifted our focus and now think of stroke on a continuum of risk based on blood pressure (BP) level rather than on a threshold effect.³ Because high BP may not exist in isolation, a wider definition of hypertension has been proposed that also takes into account the absolute risk of cardiovascular events and associated metabolic factors or early disease markers.³

Lowering BP reduces the risk of stroke. Epidemiological studies have shown that for each 10 mm Hg lower systolic blood pressure (SBP), there is a decrease in risk of stroke of approximately one third in persons aged 60 to 79 years. This association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, stroke subtypes, and for fatal and nonfatal events.⁴ Lowering diastolic blood pressure (DBP) was once the main target to achieve stroke and other cardiovascular event reduction, but SBP has now become the target.³ As recently shown, even the elderly with sustained SBP elevation may gain from BP reduction in relation to less fatal or nonfatal stroke, death, and heart failure.⁵

Although the role of longer-term BP control to improve outcomes in patients with stroke is undisputed, BP management immediately after a stroke remains controversial. In an effort to resolve this controversy, several pilot clinical . . . [Full Text of this Article]